Reducing chemotherapy waiting times at a comprehensive cancer centre through telephonic triaging
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20250914Keywords:
Chemotherapy, Chemotherapy wait time, Phone call, Satisfaction, Healthcare organisationAbstract
Background: In day-care chemotherapy facilities, long chemotherapy infusion wait times negatively impact patient experience. To resolve this problem, we implemented a quality improvement initiative using the - determining the problem, measuring the baseline, analysing the current situation, implementing the intervention, and controlling the improvement (DMAIC) methodology.
Methods: This study was conducted at the Department of Medical Oncology at the Amrita Institute of Medical Sciences, Kochi, from April to November 2019 in three phases. Phase 1 identified delay points from registration to the time of discharge using electronic records. Phase 2, after stakeholder input, implemented telephonic triaging (verification of laboratory results, health assessment and whether they recovered from the side effects) and pre-prepared chemotherapy orders. Phase 3 optimized scheduling - such as providing early slots for patients with chemotherapy infusion taking more than six hours, patients travelling long distances to the care centre, and vulnerable populations (older adults and children).
Results: We evaluated 1029 patients (409 males and 620 females) who underwent day-care chemotherapy. A pre- and post-comparative study across all phases revealed a significant reduction in mean waiting time. From a baseline of 3.5 hours, waiting time decreased to 2.4 hours in phase II and further to 1.6 hours in phase III, representing a 48.57% reduction.
Conclusions: Telephonic triaging and patient counselling prior to scheduled chemotherapy reduced wait times and unnecessary visits, streamlining workflow and improving patient care. This program, requiring only workflow restructuring with existing resources, offers a feasible model for other departments seeking to improve patient care and efficiency.
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References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. DOI: https://doi.org/10.3322/caac.21834
Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 and projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022:156(4&5);598-607. DOI: https://doi.org/10.4103/ijmr.ijmr_1821_22
Mahrous M, El Shaer E, Rezik L, Taha S, Yosef A. Decreasing prolonged waiting times for chemotherapy administration for patients with cancer. Glob J Quality Safety Healthc. 2018;1(2):44-8. DOI: https://doi.org/10.4103/JQSH.JQSH_8_18
Kallen MA, Terrell JA, Lewis-Patterson P, Hwang JP. Improving wait time for chemotherapy in an outpatient clinic at a comprehensive cancer center. J Oncol Pract. 2012;8(1):e1-7. DOI: https://doi.org/10.1200/JOP.2011.000281
Lacy NL, Paulman A, Reuter MD, Lovejoy B. Why we don’t come: patient perceptions on no-shows. Ann Fam Med. 2004;2(6):541-5. DOI: https://doi.org/10.1370/afm.123
Paterson BL, Charlton P, Richard S. Non‐attendance in chronic disease clinics: a matter of non‐compliance? J Nurs Health care Chronic Illn. 2010;2(1):63-74. DOI: https://doi.org/10.1111/j.1752-9824.2010.01048.x
Plourde CL, Varnado WT, Gleaton BJ, Lovejoy B. Reducing infusion clinic wait times using quality improvement. JCO Oncol Pract. 2020;16(8):e807-13. DOI: https://doi.org/10.1200/JOP.19.00643
Ahmed S. Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Rev Environ Health. 2019;34(4):427-34. DOI: https://doi.org/10.1515/reveh-2019-0003
Hendershot E, Murphy C, Doyle S, Van-Clieaf J, Lowry J, Honeyford L. Outpatient chemotherapy administration: decreasing wait times for patients and families. J Pediatr Oncol Nurs. 2005;22(1):31-7. DOI: https://doi.org/10.1177/1043454204272539
Ahmed Z, Elmekkawy T, Bates S. Developing an efficient scheduling template of a chemotherapy treatment unit: A case study. Australas Med J. 2011;4(10):575-88. DOI: https://doi.org/10.4066/AMJ.2011.837
Soh TIP, Tan YS, Hairom Z, Ibrahim M, Yao Y, Wong YP, et al. Improving wait times for elective chemotherapy through pre-preparation: A quality-improvement project at the national university cancer institute of Singapore. J Oncol Pract. 2015;11(1):e89-94. DOI: https://doi.org/10.1200/JOP.2014.000356
Ahmed HA. Improving Wait Time for Patients Receiving Chemotherapy at Johns Hopkins Aramco Healthcare Oncology Center: A Clinical Practice Quality Improvement Initiative. J Cancer Res Therap Oncol. 2020;8:1-8.
Hashemi-Sadraei N, Sasankan S, Crozier N, Tawfik B, Kittson R, Abernathy J, et al. Improving outpatient infusion clinic wait times at a Comprehensive Cancer Center. JCO Oncol Pract. 2021;17(12):e1935-42. DOI: https://doi.org/10.1200/OP.21.00118
Macleod A, Campbell F, Macrae D, Gray E, Miller L, Beattie M. Reducing wait time for administration of systemic anticancer treatment (SACT) in a hospital outpatient facility. BMJ Open Qual. 2020;9(4):e000904. DOI: https://doi.org/10.1136/bmjoq-2019-000904
Gupta A, Li J, Tawfik B, Pham T, Pham T, Pathak S, Singh P, et al. Reducing wait time between admission and chemotherapy initiation. J Oncol Pract. 2018;14(5):e316-23. DOI: https://doi.org/10.1200/JOP.17.00028
Aboumater HJ, Winner LE, Davis RO, Trovitch PB, Berg MM, Violette KM, et al. No time to waste: decreasing patient wait times for chemotherapy administration using automated prioritization in an oncology pharmacy system. Am J Manag Care. 2008;14(5):309-16.
Marino P, Touzani R, Seguin L, Moulin JF, Palomares M, Cappiello MA, et al. Advance Approval of Outpatient Chemotherapy via Phone Call Optimizes Healthcare Delivery without Compromising Patient Satisfaction with Care. Cancers (Basel). 2021;13(6):1337. DOI: https://doi.org/10.3390/cancers13061337
Aziz A, Samoon Z, Khurshid M, Feroz A, Ayoub N, Awan S, et al. Clinical audit to assess delays in chemotherapy administration at daycare oncology center at a tertiary care hospital in Karachi, Pakistan. Indian J Cancer. 2018;55(1):111-4. DOI: https://doi.org/10.4103/ijc.IJC_493_17